Otosclersis耳鼻咽喉科学课件.ppt

Otosclerosis Chunfu Dai Otolaryngology Department Fudan University Background Definition primary metabolic bone disease of the otic capsule and ossicles It causes fixation of the ossicles (stapes) It results in conductive or mixed hearing loss. It is genetically-mediated via autosomal dominant transmission Epidemiology Race incidence of microscopic otosclerosis Caucasian 10% Asian 5% African American 1% Native American 0% Epidemiology Sex variation (M:F=1:2.5) Women more commonly seek medical attention for hearing loss secondary to otosclerosis, histologic studies prevalence of otosclerosis show no difference in men versus women. Epidemiology Age The incidence of otosclerosis increases with age. The most common age group presenting with hearing loss from otosclerosis is 15-45 years, however it has been reported to manifest as early as 7 years and as late as the mid 50s. Etiology Many theories have been proposed such as hereditary, 54% of patients present with family history endocrine, women with pregnancy worse her hearing metabolic, enzyme abnormal was pathogen infectious, virus was identified in the lesion vascular, autoimmune, none have be proven. Hormonal factors have been suggested to play a role in otosclerosis based on the observation that pregnancy sometimes accelerates the progression of the disease. Pathophysiology Otosclerosis (otospongiosis) is an osseous dyscrasia, limited to the temporal bone, and characterized by resorption and formation of new bone in the area of the ossicles and otic capsule. Pathophysiology The most common site of involvement is the anterior oval window near the fistula ante fenestrum. When both the anterior and posterior ends of the footplate are involved it is termed “bipolar” involvement or fixation (if the footplate is immobile). If only the footplate is involved, it is sometimes referred to as a “stapedial otosclerosis”. When the entire footplate and annular ligament are involved it